US20180125487A1 - Surgical stapling apparatus with tissue pockets - Google Patents
Surgical stapling apparatus with tissue pockets Download PDFInfo
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- US20180125487A1 US20180125487A1 US15/344,091 US201615344091A US2018125487A1 US 20180125487 A1 US20180125487 A1 US 20180125487A1 US 201615344091 A US201615344091 A US 201615344091A US 2018125487 A1 US2018125487 A1 US 2018125487A1
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- tissue
- pockets
- contact surface
- stapling apparatus
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
Definitions
- the present disclosure relates to surgical stapling apparatus for performing endoscopic surgical procedures and methods of use thereof.
- Surgical stapling apparatus that clamp, cut and/or staple tissue between opposing jaw structure are well known in the art.
- Such surgical stapling apparatus can include loading units with a tool assembly having two elongated jaw members used to capture or clamp tissue.
- One of the two jaw members usually carries a staple cartridge that houses a plurality of staples while the other of the two jaw members has an anvil for forming the staples as the staples are driven from the staple cartridge into a stapling area defined between the two jaw members.
- a stapling operation is effectuated by a drive member (e.g., a cam bar, a drive sled or other similar mechanism) having a cam member that travels longitudinally through channels defined in the staple cartridge and acts upon staple pushers in the channels to sequentially eject the staples from the staple cartridge. Additional stapling may be required when tissue captured between the two jaw members migrates from the stapling area in response to the compressive forces acting on the tissues resulting from the longitudinal travel of the drive member along the two jaw members as the stapling apparatus is fired.
- a drive member e.g., a cam bar, a drive sled or other similar mechanism
- a surgical stapling apparatus includes a first jaw member, a plurality of staples, a second jaw member, and a tissue pocket.
- the first jaw member has a first tissue contact surface that defines staple retention slots. Each of the staples is received in a respective one of the staple retention slots of the first tissue contact surface.
- the second jaw member has a second tissue contact surface that defines staple pockets aligned with the staple retention slots of the first tissue contact surface. Each staple pocket of the second tissue contact surface is configured to form a respective one of the staples as the surgical stapling apparatus is fired.
- the tissue pocket is defined in one of the first or second tissue contact surfaces and configured to capture tissue therein to prevent the tissue from migrating away from the first and second tissue contact surfaces as the surgical stapling apparatus is fired.
- the tissue pocket may be positioned between two adjacent staple retention slots of the staple retention slots.
- the tissue pocket may be positioned between two adjacent staple pockets of the staple pockets.
- the surgical stapling apparatus may further include a second tissue pocket defined in one of the first or second tissue contact surfaces.
- the tissue pocket may include tissue pockets defined in the first tissue contact surface and positioned along the first jaw member between the staple retention slots.
- the tissue pocket may include tissue pockets defined in the second tissue contact surface and positioned along the second jaw member between the staple pockets.
- the tissue pocket may include tissue pockets including a first set of tissue pockets and a second set of tissue pockets.
- the first set of tissue pockets may be defined in the first tissue contact surface and positioned along the first jaw member between the staple retention slots.
- the second set of tissue pockets may be defined in the second tissue contact surface and positioned along the second jaw member between the staple pockets.
- the first jaw member may extend to a first peripheral edge and the second jaw member may extend to a second peripheral edge.
- the tissue pocket may be defined in one of the first or second peripheral edges.
- the tissue pocket may include tissue pockets defined in one or both of the first and second peripheral edges.
- the tissue pockets may include a first set of tissue pockets and a second set of tissue pockets.
- the first set of tissue pockets may be defined in the first tissue contact surface at a location offset from the first peripheral edge.
- the second set of tissue pockets may be defined in the second tissue contact surface at a location offset from the second peripheral edge.
- the tissue pocket may define an open curve. In some embodiments, the tissue pocket may define a closed curve.
- an end effector for a surgical stapling apparatus includes a cartridge assembly, an anvil assembly, a knife assembly, and a tissue pocket.
- the cartridge assembly has a first tissue contact surface and the anvil assembly has a second tissue contact surface.
- the anvil assembly and the cartridge assembly are positioned to move between an open position and a closed position to selectively clamp tissue between the first and second tissue contact surfaces.
- the knife assembly includes a knife configured to move relative to the anvil and cartridge assemblies to sever tissue clamped between the first and second tissue contact surfaces of the anvil and cartridge assemblies, respectively.
- the tissue pocket is defined in one of the first or second tissue contact surfaces and is configured to capture tissue therein to prevent the tissue from migrating away from the first and second tissue contact surfaces as the knife moves relative to the anvil and cartridge assemblies.
- the end effector further includes a second tissue pocket defined in one of the first or second tissue contact surfaces.
- the tissue pocket may include tissue pockets defined in the first tissue contact surface and tissue pockets defined in the second tissue contact surface.
- the cartridge member may extend to a first peripheral edge and the anvil assembly may extend to a second peripheral edge.
- the tissue pocket may be defined in one of the first or second peripheral edges.
- the tissue pocket may include tissue pockets defined in one or both of the first and second peripheral edges.
- the tissue pockets may include a first set of tissue pockets and a second set of tissue pockets.
- the first set of tissue pockets may be defined in the first tissue contact surface at a location offset from the first peripheral edge.
- the second set of tissue pockets may be defined in the second tissue contact surface at a location offset from the second peripheral edge.
- an end effector includes a cartridge assembly, an anvil assembly, and one or more tissue pockets.
- the cartridge assembly has a first tissue contact surface and the anvil assembly has a second tissue contact surface.
- the anvil and cartridge assemblies are operably coupled together and are positioned to move between an open position and a closed position to selectively clamp tissue between the first and second tissue contact surfaces.
- the one or more tissue pockets are defined in one of the first or second tissue contact surfaces and are configured to capture tissue therein while the anvil and cartridge assemblies are disposed in the closed position.
- the one or more tissue pockets are configured to prevent the tissue from migrating away from the first and second tissue contact surfaces while the tissue is clamped between the first and second tissue contact surfaces.
- FIG. 1 is a perspective view of a surgical stapling apparatus in accordance with the principles of the present disclosure
- FIG. 2 is a perspective view of a loading unit of the surgical stapling apparatus of FIG. 1 ;
- FIG. 3 is an enlarged, perspective view of a portion of an end effector of the loading unit of FIG. 2 with the end effector in an open position;
- FIG. 3A is a bottom view of a portion of an anvil assembly of the end effector of FIG. 3 ;
- FIG. 4 is a perspective view of the end effector of FIG. 3 shown in a closed position with tissue clamped between the anvil assembly and a cartridge assembly of the end effector;
- FIG. 5 is an enlarged, cross-sectional view of taken along section line 5 - 5 of FIG. 4 ;
- FIG. 6 is a schematic illustration of a medical work station and operating console in accordance with the present disclosure.
- distal refers to that portion of the apparatus, and/or component thereof, farther from the user
- proximal refers to that portion of the apparatus, and/or component thereof, closer to the user.
- clinical refers to a doctor, nurse, or other care provider and may include support personnel.
- tissue migration refers to travelling movement of tissue from a stapling area of a surgical stapling apparatus in response to extrusion forces, compression forces and/or other similar forces imparted to the tissue as a result of operation of the surgical stapling apparatus.
- tissue migration or the like refers to travelling movement of tissue from a stapling area of a surgical stapling apparatus in response to extrusion forces, compression forces and/or other similar forces imparted to the tissue as a result of operation of the surgical stapling apparatus.
- an electromechanical surgical stapling system or apparatus includes a surgical device 100 in the form of a powered handheld electromechanical instrument, an adapter assembly 200 , and a surgical loading unit (e.g., multiple- or single-use loading unit) or an end effector 300 .
- the end effector 300 includes an anvil assembly 310 and a cartridge assembly 320 that are movable between an open position ( FIG. 3 ) and a closed position ( FIG. 4 ) to selectively clamp tissue “T” ( FIG.
- the cartridge assembly 320 includes a stapling and cutting cartridge or reload 330 that may be selectively removable from the cartridge assembly 320 .
- the surgical device 100 is configured for selective connection with the adapter assembly 200 , and, in turn, the adapter assembly 200 is configured for selective connection with the end effector 300 . Together, the surgical device 100 and the adapter assembly 200 cooperate to actuate the end effector 300 .
- the surgical device 100 of the electromechanical surgical stapling system 10 defines a longitudinal axis “X” and includes a handle housing 102 that defines a cavity “C” for selective removable receipt of a rechargeable battery 103 .
- the battery 103 is configured to supply power to electrical components of the surgical device 100 .
- the cavity “C” supports a controller or circuit board 105 configured to control various operations of the surgical device 100 and a drive mechanism 106 configured to drive rotatable shafts and/or gear components (not shown) within the handle housing 102 in order to perform various operations of the surgical device 100 .
- the drive mechanism 106 may be operable to selectively articulate and/or rotate the end effector 300 about, and/or relative to, the longitudinal axis “X” of the electromechanical surgical stapling system 10 ; to selectively move the anvil assembly 310 and/or the cartridge assembly 320 with respect to one another between the open and closed positions to clamp tissue; and/or to fire the reload 330 .
- the battery 103 , controller 105 , and/or drive mechanism 106 may be operably coupled to one or more triggers 107 a , 107 b such as finger-actuated control buttons, rocker devices, and/or the like to effectuate various functions of the electromechanical surgical stapling system 10 such as those described above.
- the surgical stapling apparatus is described as an electromechanically powered surgical stapling apparatus
- the presently disclosed surgical stapling apparatus can be provided as a manually powered stapling apparatus.
- an exemplary manually powered stapling apparatus one or more components of which can be combined and/or interchanged with the electromechanically powered stapling apparatus described herein, reference can be made to U.S. Pat. No. 8,777,082, filed Dec. 20, 2012, the entire contents of which are incorporated by reference herein.
- the presently disclosed surgical stapling apparatus can provided as any suitable surgical stapling apparatus such as a transverse stapling apparatus, an open stapling apparatus, an endoscopic stapling apparatus, a circular stapling apparatus and/or combinations of one or more components of one or more of these stapling apparatus.
- a transverse stapling apparatus such as a transverse stapling apparatus, an open stapling apparatus, an endoscopic stapling apparatus, a circular stapling apparatus and/or combinations of one or more components of one or more of these stapling apparatus.
- U.S. Pat. No. 7,407,075 for a general description of examples of each of these surgical stapling apparatus, and/or to U.S. Pat. No. 5,915,616 (circular stapling apparatus), U.S. Pat. No. 6,202,914 (open stapling apparatus), U.S.
- the anvil assembly 310 of the end effector 300 includes an anvil body 312 and an anvil plate 314 supported on the anvil body 312 .
- the anvil plate 314 extends to peripheral edges 315 and includes a tissue contact surface 314 a ( FIG. 3A ).
- the tissue contact surface 314 a of the anvil plate 314 defines staple forming pockets 314 b configured to receive and form staples 334 ejected from the cartridge assembly 320 .
- the staple forming pockets 314 b of the tissue contact surface 314 a are positioned in one or more rows that may be in the form of longitudinal arrays along the tissue contact surface 314 a .
- Adjacent staple forming pockets 314 b of the tissue contact surface 314 a may be disposed in longitudinally and/or laterally spaced relation.
- adjacent staple forming pockets 314 b and/or inner and/or outer tissue pockets 314 d , 314 c may be in the form of annular arrays that are radially spaced apart (e.g., a circular stapling apparatus).
- the anvil plate 314 further includes outer tissue pockets 314 c formed in the peripheral edges 315 of the tissue contact surface 314 a of the anvil plate 314 and inner tissue pockets 314 d formed along the tissue contact surface 314 a at locations adjacent to the staple forming pockets 314 b and between the outer tissue pockets 314 c .
- adjacent inner tissue pockets 314 d may be positioned at longitudinally and/or laterally spaced locations relative to one another along the tissue contact surface 314 a of the anvil plate 314 .
- Each of the inner and outer tissue pockets 314 c and 314 d are configured to capture tissue “T” clamped between the anvil and cartridge assemblies 310 , 320 while the anvil and cartridge assemblies 310 , 320 are disposed in the closed position ( FIG. 4 ) to prevent tissue migration during a firing of the surgical system 10 .
- the anvil plate 314 also defines a knife channel 314 e that extends longitudinally through the anvil plate 314 .
- the knife channel 314 e may be disposed centrally between one or more of the rows of the staple forming pockets 314 b or tissue pockets 314 c , 314 d.
- the cartridge assembly 320 of the end effector 300 includes a support body 322 and a reload 330 configured for selective attachment to the support body 322 .
- the cartridge assembly 320 further supports a lead screw 324 ( FIG. 5 ) that is operatively coupled to the drive mechanism 106 ( FIG. 1 ) of the surgical device 100 to enable the drive mechanism 106 to rotate the lead screw 324 .
- the lead screw 324 is threadably coupled to a drive beam 326 and rotatable to advance the drive beam 326 along the anvil and cartridge assemblies 310 , 320 .
- the drive beam 326 supports a distally extending knife 328 and is configured to translate longitudinally through the end effector 300 to approximate/unapproximate the anvil and cartridge assemblies 310 , 320 between the open and closed positions ( FIGS. 3 and 4 , respectively) and to sever tissue “T.”
- the reload 330 of the cartridge assembly 320 includes a cartridge body 332 having a tissue contact surface 332 a .
- the tissue contact surface 332 a of the cartridge body 332 defines longitudinally extending rows of staple retention slots 332 b that support rows of staples 334 therein.
- the longitudinally extending rows of staple retention slots 332 b of the cartridge assembly 320 correspond to, and align with, the longitudinally extending rows of the staple forming pockets 314 b ( FIG. 3A ) of the anvil assembly 310 .
- the cartridge body 332 further includes tabs 332 c that snap-fit to the support body 322 of the cartridge assembly 320 .
- the reload 330 further defines a longitudinally extending knife slot 332 d that extends through the tissue contact surface 332 a and is configured to receive the knife 328 of the drive beam 326 as the drive beam 326 advances therethrough.
- the reload 330 further supports an actuation sled 336 ( FIG. 5 ) that is engagable with the drive beam 326 and advanceable along the cartridge body 332 of the reload 330 to engage pushers 338 ( FIG. 5 ) supported within the cartridge body 332 .
- the pushers 338 are positioned to support the staples 334 in the reload 330 .
- the pushers 338 are also positioned to vertically advance through the staple retention slots 332 b of the tissue contact surface 332 a of the cartridge body 332 to eject the staples 334 for formation of the staples 334 against the staple forming pockets 314 b ( FIG. 3A ) of the anvil assembly 310 as the actuation sled 336 engages the pushers 338 .
- the tissue contact surface 332 a of the reload 330 defines inner tissue pockets 332 e and outer tissue pockets 332 f that may have the same function and construction as the inner and outer tissue pockets 314 c , 314 d of the anvil assembly 310 .
- Each of the tissue pockets 314 c , 314 d , 332 e , 332 f is configured to prevent tissue migration from a stapling area “SA” ( FIG. 5 ) defined between the first and second tissue contact surfaces 314 a , 332 a of the anvil plate 314 and cartridge body 332 during a firing of the surgical system 10 ( FIG. 1 ).
- SA stapling area
- the inner and outer tissue pockets 314 d , 314 c of the anvil assembly 310 and the inner and outer tissue pockets 332 e , 332 f of the reload 330 may have any suitable shape such as circular, non-circular, polygonal, rectangular, open, closed, etc.
- the inner tissue pockets 314 d of the anvil assembly 310 and/or the inner tissue pockets 332 e of the reload 330 may include closed circular-shaped curves and the outer tissue pockets 314 c of the anvil assembly 310 and/or the outer tissue pockets 332 f of the reload may include open crescent-shaped curves.
- the outer tissue pockets 314 c , 332 f may define a scalloped profile along a length of the end effector 300 .
- one or more of the tissue pockets 314 c , 314 d , 332 e , 332 f may include multiple shapes at one location.
- One or more of the tissue pockets 314 c , 314 d , 332 e , 332 f may include any suitable dimension such as smaller and/or larger than one or more of the staple forming pockets 314 b and/or the staple retaining slots 332 b.
- the trigger 107 b ( FIG. 1 ) of the surgical instrument 100 may be actuated to cause the lead screw 324 of the end effector 300 to advance the drive beam 326 of the end effector 300 axially through the end effector 300 .
- the anvil and cartridge assemblies 310 , 320 of the end effector 300 clamp together in the closed position ( FIG. 4 ) to clamp tissue “T” in the stapling area “SA” defined between the anvil and cartridge assemblies 310 , 320 .
- the anvil and cartridge assemblies 310 , 320 clamp tissue “T” to compress the clamped tissue “CT” ( FIG. 5 ) into the inner and outer tissue pockets 314 c , 314 d , 332 e , 332 f of the respective anvil and cartridge assemblies 310 , 320 .
- the drive beam 326 pushes through and compresses the clamped tissue “CT” ( FIG. 5 ) as the knife 328 of the drive beam 326 cuts the clamped tissue “CT.”
- CT clamped tissue
- the tissue pockets 314 c , 314 d , 332 e , 332 f prevent the clamped tissue “CT” from migrating away or otherwise extruding from the stapling area “SA” in response to the pushing or compressive forces imparted on the clamped tissue “CT” as the drive beam 326 pushes through the clamped tissue “CT.”
- Reverse rotation of the lead screw 334 causes the drive beam 326 to retract so that the anvil and cartridge assemblies 310 , 320 open or to unapproximate the end effector 300 , whereby the reload 330 can be replaced so that the end effector 300 can then be re-fired as needed or desired.
- the various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.”
- Such systems employ various robotic elements to assist the clinician and allow remote operation (or partial remote operation) of surgical instrumentation.
- Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the clinician during the course of an operation or treatment.
- Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
- the robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location.
- one team of clinicians may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another clinician (or group of clinicians) remotely control the instruments via the robotic surgical system.
- another clinician or group of clinicians
- a highly skilled clinician may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
- the robotic arms of the surgical system are typically coupled to a pair of master handles by a controller.
- the handles can be moved by the clinician to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein.
- the movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the clinician.
- the scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).
- the master handles may include various sensors to provide feedback to the clinician relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the clinician with enhanced tactile feedback simulating actual operating conditions.
- the master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the clinician's ability to mimic actual operating conditions.
- a medical work station is shown generally as work station 1000 and generally may include a plurality of robot arms 1002 , 1003 ; a control device 1004 ; and an operating console 1005 coupled with the control device 1004 .
- the operating console 1005 may include a display device 1006 , which may be set up in particular to display three-dimensional images; and manual input devices 1007 , 1008 , by means of which a person (not shown), for example a clinician, may be able to telemanipulate the robot arms 1002 , 1003 in a first operating mode.
- Each of the robot arms 1002 , 1003 may include a plurality of members, which are connected through joints, and an attaching device 1009 , 1011 , to which may be attached, for example, a surgical tool “ST” supporting an end effector 1100 (e.g., a pair of jaw members) including tissue pockets in accordance with any one of several embodiments disclosed herein.
- an attaching device 1009 , 1011 to which may be attached, for example, a surgical tool “ST” supporting an end effector 1100 (e.g., a pair of jaw members) including tissue pockets in accordance with any one of several embodiments disclosed herein.
- the robot arms 1002 , 1003 may be driven by electric drives (not shown) that are connected to the control device 1004 .
- the control device 1004 e.g., a computer
- the control device 1004 may be set up to activate the drives, in particular by means of a computer program, in such a way that the robot arms 1002 , 1003 , their attaching devices 1009 , 1011 and thus the surgical tool (including the end effector 1100 ) execute a desired movement according to a movement defined by means of the manual input devices 1007 , 1008 .
- the control device 1004 may also be set up in such a way that it regulates the movement of the robot arms 1002 , 1003 and/or of the drives.
- the medical work station 1000 may be configured for use on a patient “P” lying on a patient table 1012 to be treated in a minimally invasive manner by means of the end effector 1100 .
- the medical work station 1000 may also include more than two robot arms 1002 , 1003 , the additional robot arms likewise connected to the control device 1004 and telemanipulatable by means of the operating console 1005 .
- a surgical system such as the presently disclosed surgical system, may also be attached to the additional robot arm.
- the medical work station 1000 may include a database 1014 coupled with the control device 1004 . In some embodiments, pre-operative data from patient/living being “P” and/or anatomical atlases may be stored in the database 1014 .
- the apparatus can include a loading unit with a staple cartridge assembly that is not independently replaceable, the loading unit being arranged for connection to a powered motorized surgical stapling handle, manually operated surgical stapling handle, or robotic surgical system.
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Abstract
Description
- The present disclosure relates to surgical stapling apparatus for performing endoscopic surgical procedures and methods of use thereof.
- Surgical stapling apparatus that clamp, cut and/or staple tissue between opposing jaw structure are well known in the art. Such surgical stapling apparatus can include loading units with a tool assembly having two elongated jaw members used to capture or clamp tissue. One of the two jaw members usually carries a staple cartridge that houses a plurality of staples while the other of the two jaw members has an anvil for forming the staples as the staples are driven from the staple cartridge into a stapling area defined between the two jaw members. Generally, a stapling operation is effectuated by a drive member (e.g., a cam bar, a drive sled or other similar mechanism) having a cam member that travels longitudinally through channels defined in the staple cartridge and acts upon staple pushers in the channels to sequentially eject the staples from the staple cartridge. Additional stapling may be required when tissue captured between the two jaw members migrates from the stapling area in response to the compressive forces acting on the tissues resulting from the longitudinal travel of the drive member along the two jaw members as the stapling apparatus is fired.
- It would be advantageous to provide a surgical stapling apparatus that reduces tissue migration from the stapling area for improving surgical stapling.
- According to an aspect of the present disclosure, a surgical stapling apparatus is provided. The surgical stapling apparatus includes a first jaw member, a plurality of staples, a second jaw member, and a tissue pocket. The first jaw member has a first tissue contact surface that defines staple retention slots. Each of the staples is received in a respective one of the staple retention slots of the first tissue contact surface. The second jaw member has a second tissue contact surface that defines staple pockets aligned with the staple retention slots of the first tissue contact surface. Each staple pocket of the second tissue contact surface is configured to form a respective one of the staples as the surgical stapling apparatus is fired. The tissue pocket is defined in one of the first or second tissue contact surfaces and configured to capture tissue therein to prevent the tissue from migrating away from the first and second tissue contact surfaces as the surgical stapling apparatus is fired.
- In some embodiments, the tissue pocket may be positioned between two adjacent staple retention slots of the staple retention slots.
- In certain embodiments, the tissue pocket may be positioned between two adjacent staple pockets of the staple pockets.
- In some embodiments, the surgical stapling apparatus may further include a second tissue pocket defined in one of the first or second tissue contact surfaces.
- In certain embodiments, the tissue pocket may include tissue pockets defined in the first tissue contact surface and positioned along the first jaw member between the staple retention slots.
- In some embodiments, the tissue pocket may include tissue pockets defined in the second tissue contact surface and positioned along the second jaw member between the staple pockets.
- In certain embodiments, the tissue pocket may include tissue pockets including a first set of tissue pockets and a second set of tissue pockets. The first set of tissue pockets may be defined in the first tissue contact surface and positioned along the first jaw member between the staple retention slots. The second set of tissue pockets may be defined in the second tissue contact surface and positioned along the second jaw member between the staple pockets.
- In some embodiments, the first jaw member may extend to a first peripheral edge and the second jaw member may extend to a second peripheral edge. The tissue pocket may be defined in one of the first or second peripheral edges. The tissue pocket may include tissue pockets defined in one or both of the first and second peripheral edges. The tissue pockets may include a first set of tissue pockets and a second set of tissue pockets. The first set of tissue pockets may be defined in the first tissue contact surface at a location offset from the first peripheral edge. The second set of tissue pockets may be defined in the second tissue contact surface at a location offset from the second peripheral edge.
- In certain embodiments, the tissue pocket may define an open curve. In some embodiments, the tissue pocket may define a closed curve.
- According to yet another aspect of the present disclosure, an end effector for a surgical stapling apparatus is provided. The end effector includes a cartridge assembly, an anvil assembly, a knife assembly, and a tissue pocket. The cartridge assembly has a first tissue contact surface and the anvil assembly has a second tissue contact surface. The anvil assembly and the cartridge assembly are positioned to move between an open position and a closed position to selectively clamp tissue between the first and second tissue contact surfaces. The knife assembly includes a knife configured to move relative to the anvil and cartridge assemblies to sever tissue clamped between the first and second tissue contact surfaces of the anvil and cartridge assemblies, respectively. The tissue pocket is defined in one of the first or second tissue contact surfaces and is configured to capture tissue therein to prevent the tissue from migrating away from the first and second tissue contact surfaces as the knife moves relative to the anvil and cartridge assemblies.
- In some embodiments, the end effector further includes a second tissue pocket defined in one of the first or second tissue contact surfaces.
- In certain embodiments, the tissue pocket may include tissue pockets defined in the first tissue contact surface and tissue pockets defined in the second tissue contact surface.
- In some embodiments, the cartridge member may extend to a first peripheral edge and the anvil assembly may extend to a second peripheral edge. The tissue pocket may be defined in one of the first or second peripheral edges. The tissue pocket may include tissue pockets defined in one or both of the first and second peripheral edges. The tissue pockets may include a first set of tissue pockets and a second set of tissue pockets. The first set of tissue pockets may be defined in the first tissue contact surface at a location offset from the first peripheral edge. The second set of tissue pockets may be defined in the second tissue contact surface at a location offset from the second peripheral edge.
- In accordance with still another aspect of the present disclosure, an end effector includes a cartridge assembly, an anvil assembly, and one or more tissue pockets. The cartridge assembly has a first tissue contact surface and the anvil assembly has a second tissue contact surface. The anvil and cartridge assemblies are operably coupled together and are positioned to move between an open position and a closed position to selectively clamp tissue between the first and second tissue contact surfaces. The one or more tissue pockets are defined in one of the first or second tissue contact surfaces and are configured to capture tissue therein while the anvil and cartridge assemblies are disposed in the closed position. The one or more tissue pockets are configured to prevent the tissue from migrating away from the first and second tissue contact surfaces while the tissue is clamped between the first and second tissue contact surfaces.
- Other aspects, features, and advantages will be apparent from the description, the drawings, and the claims that follow.
- The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein:
-
FIG. 1 is a perspective view of a surgical stapling apparatus in accordance with the principles of the present disclosure; -
FIG. 2 is a perspective view of a loading unit of the surgical stapling apparatus ofFIG. 1 ; -
FIG. 3 is an enlarged, perspective view of a portion of an end effector of the loading unit ofFIG. 2 with the end effector in an open position; -
FIG. 3A is a bottom view of a portion of an anvil assembly of the end effector ofFIG. 3 ; -
FIG. 4 is a perspective view of the end effector ofFIG. 3 shown in a closed position with tissue clamped between the anvil assembly and a cartridge assembly of the end effector; -
FIG. 5 is an enlarged, cross-sectional view of taken along section line 5-5 ofFIG. 4 ; and -
FIG. 6 is a schematic illustration of a medical work station and operating console in accordance with the present disclosure. - Embodiments of the presently disclosed surgical stapling apparatus are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “distal” refers to that portion of the apparatus, and/or component thereof, farther from the user, while the term “proximal” refers to that portion of the apparatus, and/or component thereof, closer to the user. As used herein, the term “clinician” refers to a doctor, nurse, or other care provider and may include support personnel. As used herein, the term “tissue migration” or the like refers to travelling movement of tissue from a stapling area of a surgical stapling apparatus in response to extrusion forces, compression forces and/or other similar forces imparted to the tissue as a result of operation of the surgical stapling apparatus. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.
- Turning now to
FIGS. 1 and 2 , an electromechanical surgical stapling system or apparatus, generally referred to as 10, includes asurgical device 100 in the form of a powered handheld electromechanical instrument, anadapter assembly 200, and a surgical loading unit (e.g., multiple- or single-use loading unit) or anend effector 300. Theend effector 300 includes ananvil assembly 310 and acartridge assembly 320 that are movable between an open position (FIG. 3 ) and a closed position (FIG. 4 ) to selectively clamp tissue “T” (FIG. 4 ) for cutting and/or stapling the tissue “T.” Thecartridge assembly 320 includes a stapling and cutting cartridge or reload 330 that may be selectively removable from thecartridge assembly 320. Thesurgical device 100 is configured for selective connection with theadapter assembly 200, and, in turn, theadapter assembly 200 is configured for selective connection with theend effector 300. Together, thesurgical device 100 and theadapter assembly 200 cooperate to actuate theend effector 300. - In some embodiments, the
surgical device 100 of the electromechanicalsurgical stapling system 10 defines a longitudinal axis “X” and includes ahandle housing 102 that defines a cavity “C” for selective removable receipt of arechargeable battery 103. Thebattery 103 is configured to supply power to electrical components of thesurgical device 100. The cavity “C” supports a controller orcircuit board 105 configured to control various operations of thesurgical device 100 and adrive mechanism 106 configured to drive rotatable shafts and/or gear components (not shown) within thehandle housing 102 in order to perform various operations of thesurgical device 100. For instance, thedrive mechanism 106 may be operable to selectively articulate and/or rotate theend effector 300 about, and/or relative to, the longitudinal axis “X” of the electromechanicalsurgical stapling system 10; to selectively move theanvil assembly 310 and/or thecartridge assembly 320 with respect to one another between the open and closed positions to clamp tissue; and/or to fire the reload 330. Thebattery 103,controller 105, and/or drivemechanism 106 may be operably coupled to one ormore triggers 107 a, 107 b such as finger-actuated control buttons, rocker devices, and/or the like to effectuate various functions of the electromechanicalsurgical stapling system 10 such as those described above. - Reference may be made to International Application No. PCT/US2008/077249, filed Sep. 22, 2008 (Inter. Pub. No. WO 2009/039506), U.S. Patent Application 2015/0157320, filed Nov. 21, 2014, and U.S. Patent Application Publication No. 2011/0121049, filed on Nov. 20, 2009, the entire contents of each of which are incorporated herein by reference, for a detailed description of the construction and operation of various exemplary electromechanical surgical systems, the components of which are combinable and/or interchangeable with one or more components of electromechanical
surgical systems 10 described herein. - Although the surgical stapling apparatus is described as an electromechanically powered surgical stapling apparatus, the presently disclosed surgical stapling apparatus can be provided as a manually powered stapling apparatus. For a more detailed description of the construction and operation of an exemplary manually powered stapling apparatus, one or more components of which can be combined and/or interchanged with the electromechanically powered stapling apparatus described herein, reference can be made to U.S. Pat. No. 8,777,082, filed Dec. 20, 2012, the entire contents of which are incorporated by reference herein. Moreover, the presently disclosed surgical stapling apparatus can provided as any suitable surgical stapling apparatus such as a transverse stapling apparatus, an open stapling apparatus, an endoscopic stapling apparatus, a circular stapling apparatus and/or combinations of one or more components of one or more of these stapling apparatus. For a more detailed description of the construction and operation of examples of such stapling apparatus, reference can be made to U.S. Pat. No. 7,407,075 for a general description of examples of each of these surgical stapling apparatus, and/or to U.S. Pat. No. 5,915,616 (circular stapling apparatus), U.S. Pat. No. 6,202,914 (open stapling apparatus), U.S. Pat. No. 5,865,361 (endoscopic stapling apparatus), and/or U.S. Pat. No. 5,964,394 (transverse stapling apparatus) for more detailed descriptions of each of these surgical stapling apparatus, the entire contents of each of which are incorporated by reference herein.
- Turning now to
FIGS. 3-5 , theanvil assembly 310 of theend effector 300 includes ananvil body 312 and ananvil plate 314 supported on theanvil body 312. Theanvil plate 314 extends toperipheral edges 315 and includes atissue contact surface 314 a (FIG. 3A ). Thetissue contact surface 314 a of theanvil plate 314 definesstaple forming pockets 314 b configured to receive andform staples 334 ejected from thecartridge assembly 320. Thestaple forming pockets 314 b of thetissue contact surface 314 a are positioned in one or more rows that may be in the form of longitudinal arrays along thetissue contact surface 314 a. Adjacentstaple forming pockets 314 b of thetissue contact surface 314 a may be disposed in longitudinally and/or laterally spaced relation. In some embodiments, adjacentstaple forming pockets 314 b and/or inner and/or outer tissue pockets 314 d, 314 c may be in the form of annular arrays that are radially spaced apart (e.g., a circular stapling apparatus). - The
anvil plate 314 further includes outer tissue pockets 314 c formed in theperipheral edges 315 of thetissue contact surface 314 a of theanvil plate 314 and inner tissue pockets 314 d formed along thetissue contact surface 314 a at locations adjacent to thestaple forming pockets 314 b and between the outer tissue pockets 314 c. For example, adjacent inner tissue pockets 314 d may be positioned at longitudinally and/or laterally spaced locations relative to one another along thetissue contact surface 314 a of theanvil plate 314. - Each of the inner and outer tissue pockets 314 c and 314 d are configured to capture tissue “T” clamped between the anvil and
cartridge assemblies cartridge assemblies FIG. 4 ) to prevent tissue migration during a firing of thesurgical system 10. Theanvil plate 314 also defines aknife channel 314 e that extends longitudinally through theanvil plate 314. Theknife channel 314 e may be disposed centrally between one or more of the rows of thestaple forming pockets 314 b or tissue pockets 314 c, 314 d. - The
cartridge assembly 320 of theend effector 300 includes asupport body 322 and a reload 330 configured for selective attachment to thesupport body 322. In some embodiments, thecartridge assembly 320 further supports a lead screw 324 (FIG. 5 ) that is operatively coupled to the drive mechanism 106 (FIG. 1 ) of thesurgical device 100 to enable thedrive mechanism 106 to rotate thelead screw 324. Thelead screw 324 is threadably coupled to adrive beam 326 and rotatable to advance thedrive beam 326 along the anvil andcartridge assemblies drive beam 326 supports adistally extending knife 328 and is configured to translate longitudinally through theend effector 300 to approximate/unapproximate the anvil andcartridge assemblies FIGS. 3 and 4 , respectively) and to sever tissue “T.” - The reload 330 of the
cartridge assembly 320 includes acartridge body 332 having atissue contact surface 332 a. Thetissue contact surface 332 a of thecartridge body 332 defines longitudinally extending rows ofstaple retention slots 332 b that support rows ofstaples 334 therein. The longitudinally extending rows ofstaple retention slots 332 b of thecartridge assembly 320 correspond to, and align with, the longitudinally extending rows of thestaple forming pockets 314 b (FIG. 3A ) of theanvil assembly 310. Thecartridge body 332 further includestabs 332 c that snap-fit to thesupport body 322 of thecartridge assembly 320. The reload 330 further defines a longitudinally extendingknife slot 332 d that extends through thetissue contact surface 332 a and is configured to receive theknife 328 of thedrive beam 326 as thedrive beam 326 advances therethrough. The reload 330 further supports an actuation sled 336 (FIG. 5 ) that is engagable with thedrive beam 326 and advanceable along thecartridge body 332 of the reload 330 to engage pushers 338 (FIG. 5 ) supported within thecartridge body 332. Thepushers 338 are positioned to support thestaples 334 in the reload 330. Thepushers 338 are also positioned to vertically advance through thestaple retention slots 332 b of thetissue contact surface 332 a of thecartridge body 332 to eject thestaples 334 for formation of thestaples 334 against thestaple forming pockets 314 b (FIG. 3A ) of theanvil assembly 310 as theactuation sled 336 engages thepushers 338. - Similar to the
tissue contact surface 314 a of theanvil assembly 310, thetissue contact surface 332 a of the reload 330 defines inner tissue pockets 332 e and outer tissue pockets 332 f that may have the same function and construction as the inner and outer tissue pockets 314 c, 314 d of theanvil assembly 310. Each of the tissue pockets 314 c, 314 d, 332 e, 332 f is configured to prevent tissue migration from a stapling area “SA” (FIG. 5 ) defined between the first and second tissue contact surfaces 314 a, 332 a of theanvil plate 314 andcartridge body 332 during a firing of the surgical system 10 (FIG. 1 ). - The inner and outer tissue pockets 314 d, 314 c of the
anvil assembly 310 and the inner and outer tissue pockets 332 e, 332 f of the reload 330 may have any suitable shape such as circular, non-circular, polygonal, rectangular, open, closed, etc. For example, the inner tissue pockets 314 d of theanvil assembly 310 and/or the inner tissue pockets 332 e of the reload 330 may include closed circular-shaped curves and the outer tissue pockets 314 c of theanvil assembly 310 and/or the outer tissue pockets 332 f of the reload may include open crescent-shaped curves. In certain embodiments, the outer tissue pockets 314 c, 332 f may define a scalloped profile along a length of theend effector 300. In some embodiments, one or more of the tissue pockets 314 c, 314 d, 332 e, 332 f may include multiple shapes at one location. One or more of the tissue pockets 314 c, 314 d, 332 e, 332 f may include any suitable dimension such as smaller and/or larger than one or more of thestaple forming pockets 314 b and/or thestaple retaining slots 332 b. - In use, the
trigger 107 b (FIG. 1 ) of thesurgical instrument 100 may be actuated to cause thelead screw 324 of theend effector 300 to advance thedrive beam 326 of theend effector 300 axially through theend effector 300. As thedrive beam 326 advances through theend effector 300, the anvil andcartridge assemblies end effector 300 clamp together in the closed position (FIG. 4 ) to clamp tissue “T” in the stapling area “SA” defined between the anvil andcartridge assemblies cartridge assemblies cartridge assemblies FIG. 5 ) into the inner and outer tissue pockets 314 c, 314 d, 332 e, 332 f of the respective anvil andcartridge assemblies - Continued distal advancement of the
drive beam 326 of theend effector 300 causes thedrive beam 326 to engage theactuation sled 336 of the reload 330 and advance through thelongitudinal knife slots anvil plate 314, respectively. Distal advancement of thedrive beam 326 advances theactuation sled 336 into engagement with thepushers 338 of the reload 330 to fire thestaples 334 from thestaple retention slots 332 b of the reload 330 for forming against the correspondingstaple forming pockets 314 b defined within theanvil plate 314 of theanvil assembly 310. As thedrive beam 326 advances, thedrive beam 326 pushes through and compresses the clamped tissue “CT” (FIG. 5 ) as theknife 328 of thedrive beam 326 cuts the clamped tissue “CT.” With portions of the clamped tissue “CT” captured within the tissue pockets 314 c, 314 d, 332 e, 332 f of the anvil andcartridge assemblies drive beam 326 pushes through the clamped tissue “CT.” - Reverse rotation of the
lead screw 334 causes thedrive beam 326 to retract so that the anvil andcartridge assemblies end effector 300, whereby the reload 330 can be replaced so that theend effector 300 can then be re-fired as needed or desired. - As can be appreciated, securement of any of the components of the presently disclosed devices can be effectuated using known fastening techniques such welding, crimping, gluing, etc.
- The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the clinician and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the clinician during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
- The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of clinicians may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another clinician (or group of clinicians) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled clinician may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
- The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the clinician to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the clinician. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).
- The master handles may include various sensors to provide feedback to the clinician relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the clinician with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the clinician's ability to mimic actual operating conditions.
- Referring also to
FIG. 6 , a medical work station is shown generally aswork station 1000 and generally may include a plurality ofrobot arms control device 1004; and anoperating console 1005 coupled with thecontrol device 1004. Theoperating console 1005 may include adisplay device 1006, which may be set up in particular to display three-dimensional images; andmanual input devices robot arms - Each of the
robot arms device - The
robot arms control device 1004. The control device 1004 (e.g., a computer) may be set up to activate the drives, in particular by means of a computer program, in such a way that therobot arms devices manual input devices control device 1004 may also be set up in such a way that it regulates the movement of therobot arms - The
medical work station 1000 may be configured for use on a patient “P” lying on a patient table 1012 to be treated in a minimally invasive manner by means of theend effector 1100. Themedical work station 1000 may also include more than tworobot arms control device 1004 and telemanipulatable by means of theoperating console 1005. A surgical system, such as the presently disclosed surgical system, may also be attached to the additional robot arm. Themedical work station 1000 may include adatabase 1014 coupled with thecontrol device 1004. In some embodiments, pre-operative data from patient/living being “P” and/or anatomical atlases may be stored in thedatabase 1014. For a more detailed description of exemplary medical work stations and/or components thereof, reference may be made to U.S. Patent Application Publication No. 2012/0116416, filed on Nov. 3, 2011, entitled “Medical Workstation” and PCT Application Publication No. WO2016/025132, filed on Jul. 21, 2015, entitled “Robotically Controlling Mechanical Advantage Gripping, the entire contents of each of which are incorporated by reference herein. - Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. For example, the apparatus can include a loading unit with a staple cartridge assembly that is not independently replaceable, the loading unit being arranged for connection to a powered motorized surgical stapling handle, manually operated surgical stapling handle, or robotic surgical system. Additionally, the elements and features shown or described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the present disclosure, and that such modifications and variations are also included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not limited by what has been particularly shown and described.
Claims (20)
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Also Published As
Publication number | Publication date |
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AU2017254951A1 (en) | 2018-05-24 |
EP3318201B1 (en) | 2020-09-23 |
ES2828716T3 (en) | 2021-05-27 |
EP3318201A1 (en) | 2018-05-09 |
US11771429B2 (en) | 2023-10-03 |
JP2018069078A (en) | 2018-05-10 |
CA2984656A1 (en) | 2018-05-04 |
US20220202419A1 (en) | 2022-06-30 |
US11642126B2 (en) | 2023-05-09 |
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